Background: Cyanotic CHD comprises up to 25% of cases of all causes of CHD. Rationale: There is lack of data about the present spectrum of congenital cyanotic heart disease in the paediatric age group. Objective: The present study was undertaken to determine the spectrum of patients with congenital cyanotic heart disease in the paediatric age group in tertiary paediatric cardiac care clinic. Design: Prospective observational study. Setting: Paediatric cardiac clinic of a tertiary cardiac care centre. Methods: All children aged 0–18 years with suspected cyanotic CHD were provisionally included in this study. They underwent a thorough echocardiographic evaluation, and those patients who had definitive diagnosis of congenital cyanotic heart disease were included for final analysis. Results: A total of 119 children met the inclusion criteria. Tetralogy of Fallot and its variant were the most common congenital cyanotic heart disease with proportion of about 44%. Other common malformations were double outlet right ventricle (14%), pulmonary atresia with ventricular septal defect (8%), total anomalous pulmonary venous connection (7%), d-transposition of the great arteries (9%), tricuspid valve anomalies − tricuspid atresia and Ebstein’s anomaly − hypoplastic left-heart syndrome, truncus arteriosus, and complex CHD such as single ventricle. Conclusion: Tetralogy of Fallot and its variants were the most common cyanotic heart disease diagnosed in our patients. As there were a significant proportion of cases with complex cyanotic CHD, paediatric cardiologists should be familiar with the diagnosis and management of all these complex congenital malformations of the heart.